Fracture Liaison Services and Long-Term Care Plan Overview

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Fracture Liaison Services Benefits of the ANZFFR Long-Term Care Plan He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Fracture Liaison Services The Magic Benefits of the ANZFFR Long-Term Care Plan! He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Fracture Liaison Services The Magic of the ANZFFR Long-Term Care Plan Pushing Shit Uphill (with a fork)!!!! He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Benefits of the Long-Term Care Plan Case Study Q and A LTCP Q and A Discussion KPI 12 Discussion Standard 5 Future questions/Food for thought He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Case Study EG Male, 58 years Anaesthetic technician Referred to FLS from GP L2 fracture lifting sheet of roofing iron-immediate back pain, NO fall 8/6/24 Physio etc. but ongoing pain. X-ray 12/11/24- Stable mild compression # L2 Extensive PMH- Kidney donor- altruistic (eGFR 65-79) Gastric bypass bariatric surgery (Roux-en-Y)2012 (130kg-82kg)=Malabsorption risk-Rx d Ca2+ lifelong , not taking now Multiple previous # s inc, pelvis 2016, distal radius 2021-trauma related Sertoli Cell Only Syndrome (infertility);Depression (ongoing Rx);TURP 2019; Sl elevated HbA1c LONG distance cycling (300km+!) Rx Losartan, Sertraline, Nortriptyline, Fe, Vit C, Centrum Vit D Normal (88 2024) DXA 2016 F-U for bariatric surgery accelerated bone loss in upper femora DXA 2025-ordered by FLS He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

DXA Result 25/3/2025 Bone Mineral Analysis Spine L1-L4: BMD 0.975 g/cm2 T Score -2.0* Z Score -1.7 Right Femoral Neck: BMD 0.852 g/cm2 T Score -1.7* Z Score -0.8 Dual Total Femur: BMD 0.915 g/cm2 T Score -1.3* Z Score -0.8 Osteoporosis Grade (WHO): Marked osteopenia. 10 Year Major Fracture Risk (FRAX UK): 4.8%* 10 Year Hip Fracture Risk (FRAX UK): 0.8%.* Follow Up Last Scan: 24/6/2016 Change in BMD: 0.094 g/cm2. Significant. Summary: Marked osteopenia in the lumbar spine with moderate osteopenia in the right femoral neck. Since the previous scan in 2016 there has been accelerated loss of spinal and upper femoral BMD. Recommendation If there is any clinical concern regarding vitamin D status, supplementation should be considered. A follow-up scan in 4 to 5 years is recommended.* Dr JF FRANZCR, Radiologist Auckland Radiology-Bay Radiology-Pacific Radiology* He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Question Time Q1 Do you use the Long-Term Care Plan? Q2 Do you use another letter? Q3 How do you deliver that letter? -Electronic/ Direct to GP ? -Email? -Post? -Other? (e.g. pigeon etc.) Q4 Do you copy the letter to the patient? He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

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Question Time 2 Q5 Does your FLS accept referrals from general practice/primary care? -Electronic? -Other? (e.g. phone, snail?, pigeon??) Q6 Does you FLS area have a Shared Electronic Health Record? Q7 Does you FLS post reports on the Electronic Health Record? Q8 Does you FLS area have Health Pathways? Q9 Does your FLS appear specifically on Health Pathways? Q9 Does your FLS issue DXA reports? He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

KPI :12 Numerator The people who received a long-term care plan developed by the FLS, in collaboration with the person and their general practitioner , within 12 weeks of the sentinel fracture Denominator The total number of fracture patients identified ANZFFR report 2025 NZ Avg 23-24 - 65% Currently (ytd) -58% Delivered 90% ??? He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Discussion: What is a joined-up FLS? Information In and Out Universal standard and access Advises current best practice Individualised advice (as far as possible/practical) Most valued and reliable source Full visibility in secondary and primary care Patient value (engagement?/involvement??) Contributes to long-term care (>1 year from sentinel fracture) The joined up FLS Most valued and reliable source Information In AND Out Contributes to long-term care (>1 year from sentinel fracture) Universal standard AND access Advises current best practice Patient VALUE Full visibility in secondary AND primary care Individualised advice He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Standard 5 (of the 5IQ) :Integration The FLS, in partnership with the person with the fracture and their general practitioner; develops a long-term care plan to reduce the risk of falls and fractures and promote long-term management. KPI 12:Provision of long-term care plan within 12 weeks And KPI 13: People taking osteoporosis specific treatment 52 weeks after fracture He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Future Questions (DONT answer now!) Is KPI 13 the king of KPIs ? Does FLS advice Trump DXA report? Are we using the Long-Term Care Plan? -Are we a fully joined-up FLS? He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent

Our Values: He mana t te wh nau Wh nau Centred T keke Equitable Manawa whakaute Respectful Pono Transparent